Diabetes Screening: Who gets it?

QUESTION

“41yo M, comes for routine examination, no significant past medical history, but has strong family history of cancer and heart disease. father and brother had MI before 55 and sister, mother and aunt, breast cancer. Pct exercises regularly, eats well, smokes one pack/weekabout

Which is an age appropriate screening test in this pct? (the answer is pasting lipid profile, but in the explanation of the wrong answers it says “this pt’s diabetes screening with fasting blood glucose should be started at 45yrs” THANX 🙂

ANSWER

Lipid screening IS the answer. This starts at age 35 in men and 45 in women.

Screening for Diabetes is to be done in adults ONLY with those with hypertension defined as a blood pressure above 135/80. This is a STRANGE BP cutoff, but that is the way it is!

 

 

Chest trauma and approach to testing

Here is the submitted question:  “A man involved in an MVA with multiple rib fractures, bruising over his chest and blah blah blah. 

CXR shows widened mediastinum, tracheal deviation, bronchial displacement and loss of the aortic knob.

 They ask the next best step in the management of this patient. The choices are Angiography of the chest, CT Chest, MRI Chest, TEE and urgent surgical consult. 

The answer that they give is CT CHest.

I understand that CT would best define what we’re looking at, but USMLE World and one of my review books says that TEE is sensitive and specific and can be used to pick up an aortic rupture. Wouldn’t that be the more logical test in this situation given the time frame

ANSWER

The TEE, CT angiogram and MRA are all equally sensitive in the detection of aortic aneurysm.

 

With multiple trauma, however, the Chest CT is better to look at all the detail to be found in the chest.  The problem with this question is NOT the testing issue, it is the fact that with such severe clinical presentation , you can easily mke the case for going straight to the Operating room.

 

Oh No Mr President! “Naw you didn’t!!”

I hope to be proved wrong and to delete this entry some time soon. I hope that I am misreading the appearance that the White House and the president have already backed off of a public option.

The Veterans hospital system is the largest in the country.

 It runs well and is cost effective

Medicare is, by far, the EASIEST insurance to use, the least number of denials and is a ‘public option”

WHERE did we get the idea that  ONLY healthcare must show budget neutral? Not AIG or the car companies?

I am enormously let down that the white house has suddenly undergone an orchiectomy!!!  Please say it isn’t so! Maybe it is an undiagnosed genetic disorder that your testicles suddenly involute at age 46?
Please say that a couple of screaming idiots as town hall meetings did NOT just derail the helathcare of millions of uninsured?  That guy who screamed at Arlen Specter last week is now running the country?

The retards who said there would be ‘death panels’ are in charge? The dumbasses who say over and over “America has the BEST healthcare in the world!!!” while Japanese women outlive us by five years and our infant mortality is edged out by Slovenia? 

No, we have the MOST EXPENSIVE healthcare!

People are stupid! Why would Aetna insurance have supported a public option if ‘Private insurance will go away” as the retards say?

Mr President, you are a very intelligent man. I hope this is a ‘strategy” and you are not surrounded by weak knee’d jellyfish.

Stand firm.

Let’s stay on message.

1. We are NOT the best. We are the MOST EXPENSIVE
2. Public works well

3. We MUST cover everyone

4 Take 100billion from defense and you will  cover it all and leave the defense budget 600billion MORE than it was 8 years ago.

New Oncology video! CURE of cancer at hand!

http://www.youtube.com/watch?v=NOGNCAwePXE

Wow!  It is REALLY hard for an oncologist to use the word ‘Cure’

Amidst all the panic and negativity of ‘How will we pay for this?” Let’s take a minute to look at what we are trying to GET TO!!

http://www.youtube.com/watch?v=NOGNCAwePXE

Step 3 CCS: Advancing the clock

Question sent in:

“Yes, I am stressed about the CCS. Also why does the software ask if I am sure that I want to advance the clock, am I penalized for advancing the clock? ”

Do NOT be distressed by the question on CCS asking if you ‘are sure’ you want to advance the clock. they are just giving you the opportunity to double check.

 

It does NOT mean you did anything wrong. It is just giving you the opportunity to be sure! Sometimes people do make a mistake.

It is like being in a relationship, and looking for re-assurance. Just say “Of Course I REALLY love you!” and say “I am SURE I want to advance!”

Treatment of Asymptomatic Bacteriuria

Ah!!! We have a controversy!!! the only CLEAR time to treat bacteriuria alone is in PREGNANT women.

The confusion: Urologic procedures such as trans-urethral resection of the prostate (TURP) or urologic procedures with BLEEDING.

The US Preventive Services Task Force (USPSTF) Says NO

The Infectious Diseases Society of America (IDSA) says YES

Who to believe? Generally,the questions do not come out of specialty organizations. they come from objective third parties like the USPSTF which have NO financial or business connections. they just look at evidence.

So, the bottom line answer is NO.

PS,

This panel is one that is REALLY cool! No manipulation No bullshit.

This is the sort of thing that some nutters are screaming about. It is what they call a ‘Death panel’ or HORROR!!!!! Do you want ‘the government’ to decide?

PPS, you see, it is what has been already done for years, it is what we WANT objective people with no corporate or profit motive.

Question on Organophosphate poisoning

“I’m confused about Organophosphate poisoning/AChE inhibitor overdose in terms of whether you give pralidoxime first to start replenishing AChE or give Atropine first to stabilize the cholinergic overactivity first.  I’m getting conflicting answers.”

RESPONSE:

Unquestionably, the MOST important thing about an acute overdose of organophosphates is to give ATROPINE. If the question has a choice of BOTH atropine and praladoxime, this would be ideal, however if there is a choice between these two, then ATROPINE in unquestionably the right answer.

Good Luck!!

Fischy

“How do I get a surgery residency?”

Hello Boys and Girls!

I will post certain questions sent to me. I will REMOVE identifying information

“i was in your live prep step 2 ck course in nyc in february…..first i wanted to thankyou for your help in the preparation of my test, i passed with a 251/99…. i am applying for general surgery in the 2010 match and was wondering if you could maybe give some advice towards where you think i would have a good chance of getting an interview.  i am originally from new york so i would like to stay in the tristate area…..
i am american and attend a 6 year program in budapest, hungary.
step 1 230/96
step 2 ck 251/99
step 2 cs should get my result in a couple of days

-thankyou for taking the time for reading my letter as i know your busy and probably get near 10000 letters just like this everyday.

RESPONSE

With the exception of the big five med schools in NYC (NYU, Cornell, Columia, Sinai, Einstein), you have a shot at MOST of the programs in NYC.
If you want to know the easiest, then look for the places that went UNFILLED last year.

Your scores should definitely get  you interviews and the lack of a need for a visa will help a lot!
Just be willing to take a preliminary spot for  a year in order to get the categorical spot you want.

And remember, tell them on interview you will undergo sterilization before the residency, you have no family, you have known since birth you wanted to be a surgeon.

Good Luck!!

Warmly, Fischy

Healthcare Reform:We have a duty to take care of ALL sick people

Start backwards from the goal: The goal is to make sure EVERYONE has the care they need. Everyone must be protected.

If you start with how much it costs, or how it will be payed for, you will not get anywhere.

Write to your friends, congress, newspaper and make them keep their eye on the ball: The  goal is to make sure everyone will have the access to care they need. Period. 70% of those without insurance are working. They are NOT dead beats, they simply have a job that does not provide coverage.

How has their voice been drowned out?

Why are they afraid to speak?

Please remember you have a duty to stand up for those who cannot protect themselves.

People, sick people, are more important than ridiculous scary words like ‘government run’ or ‘socialized’. People who use those words just don’t care about people who are suffering.

Biblical/Religious Basis of “Routine Miracles”

A few years after I graduated medical school, I noticed that the specific ‘facts’ or ‘directives’  to the disciples had actually occured.

1 Cleanse Lepers: Done in most places. Medication cost  $1.59 in 2008 dollars

2. Raise the dead: Besides implantable defibrillators we can now ERADICATE ventricular arrhythmias. Take a look http://bit.ly/wSH7B

3. Restore sight to the blind: Corneal transplant in 4 minutes, Descemet’s membrane transplant restores FULL vision in 2-3 weeks, not A YEAR! Cataracts replaced with BIFOCAL intraocular lenses.

4. Cast out demons: The population in psychiatric hospitals has dropped from 560,000 to 60,000 in the last thirty years!!

I will be discuss the calling of the physician and healer in direct religious terms ONLY in those places where I am specifically invited to do so. 

They say I have a lot of energy. I want you to know where a lot of my energy comes from. It comes from trying to heal the world and to take of  YOU who is the caregiver.

We must substitute EXCITEMENT at being in medicine at such a thrilling time for FEAR of the  future.

We must see ourselves as able to do things NOW in medicine that in the past would have required a biblical figure.

Should you wish to invite me to your church, temple, mosque or synagogue or Religious bookstore I would LOVE to come!  Please email me at Conrad.Fischer@downstate.edu

You can also contact people from publishing if I  make you nervous (Tim.Brazier@kaplan.com). He arranges my appearances.

I would MOST love to teach on this subject in Seminary, particularly to those studying for pastoral care assignments in hospitals.

“Routine Miracles” as a book is based on the quotation from the gospel of Mathew.

I need your help in this area. Please do not let me down. Now is the time to extend these benefits to all our our people.

CFischer